Advice from the docs: Sinusitis nothing to sniff at

Among the world’s billions of people, Israeli researchers claim there are only 14 types of noses! Albert Einstein’s “fleshy nose” is the most common — around 25 percent of folks sport that schnozzle. But whether you share Albert’s proboscis, have a hawk nose (like Barbra Streisand) or a bulbous nose (Bill Clinton), if you’re one of the more than 28 million North Americans with chronic sinusitis, you know (with apologies to Jimmy Durante) “the nose blows.”

Sinusitis is persistent inflammation of the sinuses that lasts for at least eight weeks, causing symptoms such as headache; facial tenderness or pain; fever; cloudy, discolored discharge; stuffiness; even sore throat and cough. The inflammation in your sinuses shows up on a CT scan despite attempted treatment. The cause? It might be from a bacterial or viral infection, allergies, polyps, a deviated septum or even an immune system condition.

Until now it’s been difficult to know how to provide effective relief. And misuse of antibiotics to treat symptoms that don’t come from bacterial infections is just plain risky. But a study in JAMA reveals daily saline irrigation (keep those neti-pots clean!) and intranasal corticosteroids are your best initial treatment. The researchers also found no effect from the routine use of antihistamines, allergy immunotherapy, topical antifungals or topical antibiotics.

And if you also have nasal polyps, try 1-3 weeks of systemic corticosteroids or three weeks of doxycycline or leukotriene-antagonist therapy. No polyps? Perhaps long-term, anti-inflammatory, macrolide therapy (three-plus months) or short-term (up to three months) non-macrolide antibiotics.